The Ontario Obsessive Compulsive Disorder Network

Cognitive Behaviour Therapy

People with OCD are usually aware that their thinking is excessive and irrational and may have already spent a great deal of time trying to figure out and change their faulty thinking. In cognitive therapy, the person is encouraged to identify irrational thoughts and attitudes and cultivate more realistic ones. Intolerance of uncertainty is at the core of almost all manifestations of OCD. One must decide to learn to live with the possibility of never being 100% certain about the many things that are causing them concern. Cognitive therapy is most effective when combined with behavioural interventions such as exposure and response (or ritual) prevention (ERP).

In ERP, the "exposure" part involves direct or imagined and controlled exposure to objects or situations that trigger obsessions that arouse anxiety, dread or avoidance. Over time, exposure to obsessional cues creates less and less anxiety, until eventually, it arouses little to none. By systematically and repeatedly confronting and overcoming feared situations, people get "used to" their obsessional cues and begin to view exposure tasks as strategies that not only control compulsive responses but inspire confidence. This process of getting "used to" obsessional cues is called "habituation". Through frequent and prolonged confrontation with situations that are feared and dreaded, the human nervous system automatically "numbs out" fear responses to more manageable levels.

The "response" in response prevention refers to stopping the rituals that people with OCD engage in to reduce their anxiety. In ERP treatment, people learn to resist the compulsion to perform rituals and are eventually able to stop these behaviours. By voluntarily blocking behaviours that reinforce obsessive worries and keep them foremost in the person's mind, worries eventually diminish. This process is referred to as "extinction". As treatment begins to take hold, old, automatic responses to OCD triggers also diminish and are replaced with more adaptive and functional behaviours.

Cognitive Behaviour Therapy helps to develop tolerance for anxiety and uncertainty. By intentionally stopping rituals in order to improve tolerance to fear provoking obsessions, one is purposely allowing the anxiety to be present, and in doing so, cultivates new adaptations based on their direct experience. Previously acquired associations between anxiety provoking stimuli and rituals are replaced with more realistic and adaptive interpretations and appraisals of the same situations. In other words, by deliberately confronting OCD related fears in a diligent and systematic manner, one soon discovers, through one's own experience, that it is possible to free from the fear of OCD triggers and the necessity to ritualize. OCD thoughts are seen as just that, thoughts which carry no special importance and therefore require no special attention. With this understanding firmly in place, OCD intrusions eventually diminish and become less bothersome. .










				Cognitive Behaviour Therapy People with OCD are usually aware that their thinking is excessive and irrational and may have already spent a great deal of time trying to figure out and change their faulty thinking. In cognitive therapy, the person is encouraged to identify irrational thoughts and attitudes and cultivate more realistic ones. Intolerance of uncertainty is at the core of almost all manifestations of OCD. One must decide to learn to live with the possibility of never being 100% certain about the many things that are causing them concern. Cognitive therapy is most effective when combined with behavioural interventions such as exposure and response (or ritual) prevention (ERP). In ERP, the "exposure" part involves direct or imagined and controlled exposure to objects or situations that trigger obsessions that arouse anxiety, dread or avoidance. Over time, exposure to obsessional cues creates less and less anxiety, until eventually, it arouses little to none. By systematically and repeatedly confronting and overcoming feared situations, people get "used to" their obsessional cues and begin to view exposure tasks as strategies that not only control compulsive responses but inspire confidence. This process of getting "used to" obsessional cues is called "habituation". Through frequent and prolonged confrontation with situations that are feared and dreaded, the human nervous system automatically "numbs out" fear responses to more manageable levels. The "response" in response prevention refers to stopping the rituals that people with OCD engage in to reduce their anxiety. In ERP treatment, people learn to resist the compulsion to perform rituals and are eventually able to stop these behaviours. By voluntarily blocking behaviours that reinforce obsessive worries and keep them foremost in the person's mind, worries eventually diminish. This process is referred to as "extinction". As treatment begins to take hold, old, automatic responses to OCD triggers also diminish and are replaced with more adaptive and functional behaviours. Cognitive Behaviour Therapy helps to develop tolerance for anxiety and uncertainty. By intentionally stopping rituals in order to improve tolerance to fear provoking obsessions, one is purposely allowing the anxiety to be present, and in doing so, cultivates new adaptations based on their direct experience. Previously acquired associations between anxiety provoking stimuli and rituals are replaced with more realistic and adaptive interpretations and appraisals of the same situations. In other words, by deliberately confronting OCD related fears in a diligent and systematic manner, one soon discovers, through one's own experience, that it is possible to free from the fear of OCD triggers and the necessity to ritualize. OCD thoughts are seen as just that, thoughts which carry no special importance and therefore require no special attention. With this understanding firmly in place, OCD intrusions eventually diminish and become less bothersome. .